Health Language Blog

A Colorado study of ambulatory practices found no significant reduction in the number of tests ordered or in the cost of tests among the participants of a Health Information Exchange (HIE). The Study analyzed claims data from Rocky Mountain Health Plans, a leading health plan in the market, for 306 providers in 69 practices in Mesa County, CO. The study compared the number of tests ordered and their costs before and after the providers joined the HIE, which was launched in 2005 by Quality Health Network (QHN). By 2010, 85 percent of the providers in the area were participating in the HIE. The study was published in the Journal of the American Medical Informatics Association.

The number of tests ordered by primary care physicians and specialists rose during the five-year period, but dropped significantly once they joined the HIE. However, HIE adoption had little effect on costs. For radiology tests, there was little difference in either the number of tests ordered or the costs.

The HIE's economic benefit, the authors surmised, could come through "downstream outcomes of better informed, higher quality care." Lead author Steve Ross, MD, associate clinical professor at the University of Colorado School of Medicine, told InformationWeek that the number of practices using the HIE didn't reach critical mass until 2008, and it was unclear whether physicians used it simply to get test results into their EHR.

However, physicians were less likely to go outside their EHR to look up clinical data from the QHN website, so the HIE might have been more effective had practitioners been able to look up information within their own EHRs. That aggregated data, however, is the value of the HIE, Ross said. "[That] is where you're really going to see the benefit--where you have access to something you wouldn't have had access to otherwise," he said. Less than a month later, a paper published in the Archives of Internal Medicine found that physicians who had access to an HIE ordered fewer lab tests for patients with prior test results.

A more recent study published in Medical Care found that alerts about the cost and radiation dose of imaging exams could prompt physicians to alter their orders. A study published in Health Affairs last year found that physicians with electronic access to medical imaging and lab results in an EHR actually ordered more, rather than fewer tests, setting off a debate about the value of EHRs.